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[Pollie]

Well my biopsy results (taken as a result of post menopausal bleeding at the 2 week cancer referral unit) have come back "Normal'  hoorah hoorah !!

However the report states that I have a Proliferative Endometrium which is "Unusual" for post menopause and I have a follow up appointment.

This makes me believe even more that I am peri not post.

My periods just stopped dead in Feb 2012, however I had mirena in at the time fitted in 2005 replaced 2010...... Gp did blood test May 2013 for LH and FSH which confirmed I was post meno but GP only did the one blood test. HRT oestrogen only patch started due to night sweats.

Mirena removed Dec 2014 and then had several massive bleeds in July 2015 and hormones all over the place, despite having conti patch since Dec.

I think I ovulated as I had 'egg white mucous' (TMI) and excruciatingly sore nipples and said as much to gyne consultant at my first appointment, before ultrasound and biopsies were taken, but she looked at my notes at the time and said absolutely not possible....

Any thoughts ?

[Hurdity]

Hi Pollie

First of all - great news that everything is OK re your biopsy ! 

Also - from what I've read (and including on here - see link http://www.menopausematters.co.uk/diagnose.php) you cannot diagnose a woman to be post-menopausal on the basis of one raised FSH level. It sounds from what you say that you are not (post -menopausal) which is why you have had the bleeding - as you said the Mirena often stops periods and masks the actual transition to menopause so that the only indication are other symptoms eg flushes and sweats.  What a shame that you have been put through the worry and invasiveness of an unnecessary test - although the plus side is at least you've been checked! I am assuming that your follow up appointment will check that this is the case (that you are not actually post-menopausal)?

The Mirena will be more effective than conti patch in thinning the lining ie preventing bleeding - which would explain why you have been having bleeds ( if you are still peri and especially if you are having anovulatory cycles - where you don't ovulate) - could be the progestogen in the patch just isn't strong enough to oppose the amount of oestrogen ( from your own cycle).

I presume you were checked for fibroids/polyps etc which could also play havoc with bleeding and cause more?

Strange that the gynae would look at the one reading and disregard your own observations!!

The proliferative endometrium is what occurs through oestrogen stimulation in the first half of the menstrual cycle. I'm not sure how this differs from a proliferative endometrium through oestrogen from HRT, but I would assume they are saying this because a conti patch should not normally show a proliferative endometrium because in post-menopause eventually the oestrogen/prog are well matched to prevent proliferation.

Sorry if this sounds garbled but just thinking aloud and hope it helps!

Are you on HRT still at the moment to help with sweats etc? Also how old are you?

Good luck with your follow up appointment!

Hurdity x

[Pollie]

Dear Hurdity - so knowledgeable as always - I wish I could take you in my pocket to my next appointment haha 

I am 52. I stopped Conti patch after the biopsies were taken about a month ago as the bleeding didn't stop and I just sensed  I was adding to the problem with more hormones. The bleeding stopped a few days later and has not happened again.

Obviously since stopping I have crashed big time with more meno symptoms than ever before (muscle ache, night sweats, low mood, teariness,  peeing in the night, but at least I now know they are related to hormones and nothing more sinister)

I think will probably have mirena fitted again and a separate oestrogen, patch or possibly try gel so I can control dose - I am not sure which.

What was interesting for me was that the weeks leading up to the bleed I started sleeping through the night for the first time in 8 years and also my previously untreatable plantar fasciitis that I had struggled with for 4 years got better ! I thought I was in heaven, through the menopause and out the other side ! Maybe I need a higher dose of oestrogen..

My recent ultrasound reported that one ovary contained 'a simple follicle measuring  18mm'  - is this indicative of anything ? Do you think I should ask for bloods again ? Or will they say it doesn't matter as they are just treating the symptoms.


Thanks for any thoughts

Pollie

[Hurdity]

Thank-you Pollie 

I don't know anything about follicles but I looked it up and this came up:

How big is a follicle at ovulation?

    This follicle is seen as a small cystic structure within one of the ovaries on ultrasound. That follicle will normally grow to 18-24 mm. size prior to rupture. Ultrasound can predict the approximate time of ovulation and determine whether or not the follicle has truly ruptured and released the egg for fertilization.

and this:

In a natural cycle, from the antral follicles, one called “dominant” is selected. This follicle differs from the others by its size and rapid growth. Finally will be a mature follicle or De Graaf prepared to “ovulate”. The others atresian, that is they disappear or die as part of a programmed biological process. Before ovulation occurs, the average diameter of the dominant follicle is 22 to 24 mm (range 18-36 mm). It is the only marker that can predict ovulation with ease.

from this website (some of the English sounds a bit weird):
http://www.institutobernabeu.com/foro/en/2014/09/01/what-are-follicles-number-growth-and-other-characteristics/

I would assume from this and your results that you only had one follicle but that it could be an indication that your ovaries are still working (albeit not very well) and therefore you are not yet post-menopausal? However one thing I don't know (and haven't looked up) is what happens in the ovary during the time following the last period - the next couple of years when oestrogen falls. I am wondering if several follicles start to develop but the hormone levels are too low so they don't develop properly so ovulation does not take place. Eventually I presume you may get a slight development of one or two which start, and then nothing - I try to imagine it like bubbling porridge - and then when you turn off the heat!  The fact that you felt well leading up the bleed is an indication that your hormones were working correctly and yes your oestrogen levels were rising!

When I was at your stage ( although you aren't certain what your stage is now!) ie late peri-menopause I started on an Evorel sequi patch - but the progestogen didn't suit me so I changed to separate oestrogen and progesterone and have been on that more or less ever since. My bleeds were never problematic so I assumed I must have been almsot at menopause.

By all means ask for a blood tests if this is suggested - and get them printed out - because it would be useful to have as a baseline - especially re your estradiol levels - although again if you are having some form of cycle you may not be able to tell an awful lot!

If the Mirena suited you it is defo the best option - and you won't really need to worry about whether or not you are late peri etc - and find an oestrogen dose that suits you and hopefully stay on it for as long as you want.

Hurdity x

[CLKD]

Onwards and upwards!

[SadLynda]

glad alls well with biopsy.

Hope you can move forward with other stuff now